Abstract Introduction: Reoperations in cardiac surgery represent a clinical challenge, particularly because of the higher rate of perioperative morbidity and mortality. Mitral valve reoperation owing to bioprosthesis dysfunction, transcatheter treatment with a prosthesis implantation over the prosthesis has emerged as an alternative, especially for patients with a previous approach. In this study, we analyzed the hydrodynamic behavior of transcatheter prosthesis implantation in conventional mitral bioprostheses through hydrodynamic tests and produced a recommendation for the size of transcatheter valve most adequate for valve-in-valve procedure. Methods: Mitral bioprostheses were attached to a flow duplicator and different combinations of transcatheter prostheses were implanted inside. The equipment simulates the hydrodynamic behavior of the valves submitted in vitro and determines transvalvular pressures and flow parameters. Results: All tests could be performed. Better hydrodynamic performance occurred for transcatheter prostheses 1 mm smaller than bioprostheses, except for the 27-mm bioprostheses. Effective valve areas (cm²) and transvalvular gradients (mmHg) were, respectively: Bioprosthesis × Inovare: 27 × 28 mm: 1.65 and 5.95/29 × 28 mm and 31 × 30 mm: 2.15 and 3.6. Conclusion: The mitral valve-in-valve implantation proved to be feasible in vitro. The use of 27-mm bioprostheses should be judicious, with preference for a 26-mm transcatheter valve. In the 29 and 31-mm bioprostheses, the implantation was very satisfactory, with good effective valve areas and transvalvular gradients, with preference for smaller transcatheter valves.

ABSTRACT: The evaluation of soils in representative landscapes constitutes an opportunity to evaluate spatial distribution, discuss formation processes, and apply this knowledge to land use and management. In this sense, from the perspective of an environmentally diversified region, the aim of the present study is to evaluate the occurrence and understand the formation of soils in different geomorphic surfaces of a landscape from a mountain region in the state of Rio de Janeiro. The study was developed in the Pito Aceso microbasin in the municipality of Bom Jardim, composed of narrow valleys and a rugged mountain domain, with elevation between 640 and 1,270 m. In a representative landscape, the geomorphic surfaces were obtained from the slope segments and flow lines. On the geomorphic surfaces, soil profiles were described by their morphological properties, collected, and analyzed to describe the chemical and physical properties of each horizon. Geomorphological aspects and possible variations of the parent material directly affected pedogenesis and led to distinct soil classes in the landscape. Variation in the geomorphic surfaces directs the processes for soil formation under current conditions, as well as the preservation of polygenetic soils. Soils of lower development and with greater participation of the exchangeable cations were identified at the summit (talus deposit) (Neossolo Litólico and Cambissolo Húmico) and toeslope (colluvial-alluvial) (Neossolo Flúvico), whereas more developed soils with lower nutrient content occur in the concave (Argissolos Vermelho and Amarelo) and convex (Latossolo Amarelo) backslope, except for the Argissolo Vermelho-Amarelo in the shoulder, which had high exchangeable cations contents.

O herpes zoster pode resultar em neuralgia pós-herpética, que é definida como dor prolongada predominantemente mediada por hiperatividade do sistema nervoso central. Esse fenômeno pode ser revertido pelo uso da (S)-cetamina, mas seu uso pode resultar em efeitos adversos intoleráveis, enquanto seu uso tópico parece ser seguro. Este é um estudo "cross-over" com 12 pacientes distribuídos aleatoriamente em dois grupos. Observou-se efeito importante do tempo sobre a intensidade da dor, mas não houve diferenças estatísticas do uso da SKET, ou do placebo, no escore da dor, neste esquema de tratamento. Discretas reações cutâneas foram observadas com o uso de SKET tópico.

Herpes zoster infection may cause postherpetic neuralgia, which is defined by prolonged pain predominantly mediated by central nervous system hypersensitivity. This phenomenon may be reversed by (S)-ketamine (SKET), but its use results in intolerable side effects, while its topical administration seems to be safe. It is a cross-over design study with 12 patients randomly divided into two groups. There was a significant effect of time on pain intensity, but no statistical difference in pain scores for SKET or placebo use in this sample in this treatment regimen. Only few mild cutaneous reactions were observed with topical SKET use.